The Orlando Sentinel is reporting that Florida is poised to join the ranks of states like Minnesota and Alaska in refusing to implement key elements of the Affordable Care Act. The state is already leading the way in challenging the constitutionality of reform in the court room, but Republican gains in both chambers and the election of anti-health governor Rick Scott are empowering conservatives to take an even stronger position against the law:

And perhaps most significantly, legislative leaders are poised to block spending and rules necessary to implement the law. Already, state regulators has refused to impose minimum spending mandates that might generate refunds for consumers – but which health insurers say will hurt their profits. And Gov.-elect Rick Scott has also made clear he doesn’t want the state doing anything to help the law along. [...]

But even before he was officially named speaker, Cannon warned Crist that no state agency should take any steps to comply with the law “without clear and comprehensive guidance from the Legislature.” The Oct. 19 letter demanded an itemized accounting of all state agency activities regarding the federal law.

Specifically, the letter singled out the Office of Insurance Regulation for work it has begun – and which legislative budget-writers approved – to study how Florida’s health-care laws should be amended to conform to the federal reform, and to boost the state’s ability to handle new rate-filing data.

“Not only are Florida insurance officials helping the federal government to write rules on these matters, but [OIR] is jumpstarting these new regulatory functions by developing data systems necessary for enforcement,” Cannon complained.

He added: “We intend to develop a clear and statutorily-defined framework for Florida agencies’ activities in regard to the federal health law. Pending such legislative action, state agencies should examine each anticipated action or function in light of their specific statutory authority.”

Indeed, state attempts to stop implementation are just the most immediate consequences of the Republican victories in the midterms. While the election only strengthened the Republican strong-hold over the legislature in Florida and swept into power one of the most anti-reform governors in the nation, the GOP also won control of 26 statehouse chambers around the country and elected a slate of anti-reform governors. Sam Brownback of Kansas, for instance, has called the reform law ‘an abomination,’ Bill Haslam of Tennessee, said the law is an ‘intolerable expansion’ of federal power and a ‘reminder of the incredible arrogance of Washington,’ and Maine’s incoming governor, Paul LePage who promised to repeal the Affordable Care Act and is now preparing to eliminate Dirigo, the state’s expanded health care program.

Of course, even the most vocal Republican opponents won’t be able to repeal the federal law outright. But they will do their best to slow the pace of implementation, lean on congressional delegations to change the legislation, seek waivers (as both Florida and Maine have already done) and pressure state agencies to stop cooperating with federal requirements. The big question will be if Florida and the other anti-reform states will fall into Gov. Tim Pawlenty’s (R-MN) pattern of accepting ACA dollars while rallying against the law. The Orlando Sentinel notes that the state has already “been awarded $43 million in grants to provide $250 rebates to seniors who fall into the “donut hole” in the Medicare prescription drug program; to help prepare the Office of Insurance Regulation to evaluate out-of-state insurers seeking to sell health coverage in the state; and to plan for creating a health-care marketplace, or “exchange,” and other changes.” It’s worth asking Scott if he’s planning on sending back the money or applying for future grants.

Throughout the health care debate, Republicans characterized Medicaid as a “medical ghetto” and blasted Democrats for proposing to expand the program.” “We’ve heard eloquent statements about how moving 15 million low-income Americans into a program called Medicaid, which is a medical ghetto, is not health care reform,” Sen. Mike Enzi (R-WI) said on the Senate floor in November of 2009. Rep. Virginia Foxx (R-NC) even suggested that people are better off uninsured than insured under Medicaid.

And while Republicans may think they’re too good for Medicaid coverage, a 2005 Kaiser Family Foundation poll found that 74 percent of Americans consider Medicaid very important and most would oppose cuts to the program. In fact, the economic downturn has greatly increased the number of Americans dependent on the Medicaid program, with enrollment increasing by 8.5 percent in fiscal year 2010. But this increased eligibility has also blown a hole is state budgets and is forcing governors and legislators across the country to limit spending on the program. The Clarion Ledger is reporting that Gov. Haley Barbour (R-MS) — a potential presidential contender in 2012 — is “pushing to cut Medicaid payments to hospitals, nursing homes and other providers in a sweeping proposal that critics say could curtail access to health care“:

Barbour built a large part of his 2012 fiscal budget on a proposal to return rates for providers, excluding physicians, to fiscal 2010 levels, a move the Division of Medicaid says could save about $60 million.

Barbour says this and other reforms could free up some $82 million in Medicaid expenses for education, public safety and other state functions. [...]

“We’re going to look at his proposal and we’re going to look real hard for what is good in it, but very few of the governor’s proposals on Medicaid policy have been something that would improve the program,” said House Medicaid Committee Chairman Dirk Dedeaux, D-Perkinston. “Most of the things he proposes are ways to cut the program. In these economic times, that program has a very high demand serving a number of people who have lost their income.” [...]

What Barbour proposes would amount to a 4 percent cut for nursing homes and an 8 percent cut for hospitals and other providers, the governor’s office reports.

Medicaid officials said they, like counterparts at other agencies, were charged with finding ways to trim costs in harsh economic times for the state.

The federal government bolstered the Medicaid budget with stimulus money – the feds putting up about 85 cents for every 15 cents the state contributed. That rate resets next year to roughly a 75-25 split.

Barbour’s actions are certainly no anomaly (and if anything, call for a serious conversation about Medicaid reform and possibly federalizing the Medicaid program). According to the Kaiser Family Foundation, state spending on Medicaid rose an average of 8.8 percent — the biggest increase in eight years and the second biggest jump in two decades. Consequently, at least 20 states have reduced or restricted benefits in 2010, 39 cut or froze reimbursements for doctors and hospitals, 14 states have plans to cut benefits and 37 to restrict fees in 2011.

All of these cuts will have the effect of reducing access to providers — who already complain that they are greatly underpaid by the program — and may cause providers to reduce services and staff. But Barbour’s cuts are particularly noteworthy because they come from a Governor who has become the GOP’s national spokesperson against health reform. He regularly conflates cuts in Medicare with rationing, arguing that the health care law would undermine access for both patients and devastate providers, and has railed against the law’s Medicaid expansion.

But here he is advancing a proposal that would destabilize Mississippi’s health care system and all concerns about limiting patient access to providers are out the window. After all, these cuts are necessary to free-up state dollars “for education, public safety and other state functions.” Never mind that Mississippi has “the highest poverty rate in the nation and some of the sickest people, with the country’s highest rate of heart disease and the second-highest rate of diabetes.”

Barbour only reiterates the sheer hypocrisy of the Republican attacks, for not only is he cutting deep into Medicaid, but he’s also contributing to the very same kind of “medical ghetto” that his party so vehemently opposed expanding.